Healthcare Provider Details

I. General information

NPI: 1730657909
Provider Name (Legal Business Name): CONSTANCE FRAZIER RD, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 HAYMAKER RD STE 101
MONROEVILLE PA
15146-3555
US

IV. Provider business mailing address

2566 HAYMAKER RD STE 101
MONROEVILLE PA
15146-3555
US

V. Phone/Fax

Practice location:
  • Phone: 412-858-4474
  • Fax: 412-858-3033
Mailing address:
  • Phone: 412-858-4474
  • Fax: 412-858-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000271
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: